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Valvotomy for isolated congenital aortic stenosis in children: prognostic factors for outcome
E P Bauer1, J Schmidli, P R Vogt
1Clinic for Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
Insights
Surgery for congenital valvar aortic stenosis in children shows good long-term survival, but reoperation and valve dysfunction are common. Younger infants face higher early mortality risks. Careful monitoring is crucial for these pediatric cardiac patients.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Congenital Heart Disease
Background:
- Congenital valvar aortic stenosis is a significant cause of pediatric heart disease.
- Surgical outcomes in children require long-term evaluation.
Purpose of the Study:
- To evaluate early and late outcomes of surgical treatment for isolated congenital valvar aortic stenosis in children.
- To identify prognostic factors for mortality and reoperation.
Main Methods:
- Retrospective analysis of 86 children under 16 years undergoing surgery for congenital valvar aortic stenosis.
- Primary procedures were conservative.
- Actuarial survival and reoperation-free intervals were calculated.
Main Results:
- Early mortality was 8.1%, primarily in infants under 4 months; age and cardiopulmonary bypass duration were risk factors.
- Late mortality was 7.7%.
- Actuarial survival reached 87% at 20 years. Reoperation was needed in 28% of survivors, with long follow-up being a key factor. Poor valve function was associated with longer follow-up, endocarditis, and young age at operation.
Conclusions:
- Surgery for congenital valvar aortic stenosis offers good long-term survival in children.
- Reoperation and valve dysfunction are significant long-term concerns.
- Younger age at operation and longer follow-up are associated with poorer valve function and increased reoperation risk.
Abstract:
Early and late results after surgery for isolated congenital valvar aortic stenosis were evaluated in a total of 86 children under 16 years of age (mean 7.4 years). Primary procedure was always conservative. There were 7/86 (8.1%) early deaths. All infants who died after the operation were younger than 4 months of age. Among the clinical variables tested by the univariate analysis only age and duration of cardiopulmonary bypass were significant prognostic factors for early death. There were 6/67 (7.7%) valve-related late deaths. Multivariate analysis could not identify any risk factors for early and late mortality. Actuarial survival was 97% (95% CL 93-101%) after 5 years, 94% (88-100%) after 10 years, 90% (82-98%) after 15 years, and 87% (77-97%) after 20 years. A total of 22/79 (28%) early survivors had a first reoperation and 5 had a second reoperation. Long follow-up interval was the only significant factor for reoperation. Actuarial reoperation-free interval was 91% (85-98%) after 5 years, 70% (58-81%) after 10 years, and 50% (34-64%) after 15 years. Significant factors for poor valve function were long duration of follow-up, endocarditis, and young age at operation. The probability of normal valve function was 91% (84-98%) after 5 years, 67% (55-79%) after 10 years, and 54% (40-68%) after 15 years.